Thrombophilia and venous thromboembolism: RIETE experience

Monreal, Manuel; Campo, Raquel; Papadakis, Emmanouil

doi:10.1016/j.beha.2012.07.007

Cited by 11 publications

(7 citation statements)

References 25 publications

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“…However, recently published findings of the large RIETE (Registro Informatizado de Enfermedad TromboEmb olica) registry support our results insofar as hereditary thrombophilia is more prevalent in younger VTE patients (Monreal et al, 2012). However, in the RIETE study, thrombophilia screening was not routinely performed, and only 21% of patients underwent testing (Monreal et al, 2012). Another study reported that hereditary thrombophilia (F5 R506Q or F2 G20210A mutation, deficiencies of AT, PC or PS) is especially more prevalent among younger patients with unprovoked DVT when compared with patients older than 45 years or with those with risk-associated DVT (De Stefano et al, 2002).…”

Section: Discussionsupporting

confidence: 88%

“…In summary, the literature data are limited and contradictory. However, recently published findings of the large RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry support our results insofar as hereditary thrombophilia is more prevalent in younger VTE patients (Monreal et al , ). However, in the RIETE study, thrombophilia screening was not routinely performed, and only 21% of patients underwent testing (Monreal et al , ).…”

Section: Discussionsupporting

confidence: 88%

“…Genetic and environmental risk factors may therefore act differentially at various ages. In addition, it has been proposed that genetic risk factors are relevant particularly in VTE in young individuals and that other risk factors (e.g., cancer, immobilization) may play a more important role in the increased incidence of VTE in the elderly (Engbers et al , ; Monreal et al , ). Using data from the Main‐ISar‐THROmbosis registry, we aimed to analyse the prevalence of thrombophilia in different age groups to help determine whether to screen for thrombophilia.…”

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confidence: 99%

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Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry

et al. 2013

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SummaryThrombophilia is a well-established risk factor for a venous thromboembolic event (VTE), and it has been proposed that hereditary thrombophilia may substantially contribute to the development of VTE in young patients. We aimed to analyse the prevalence of thrombophilia with special regard to the age of VTE manifestation. The study cohort consisted of 1490 patients (58% females) with a median age 43 years at the time of their first VTE. At least one thrombophilic disorder was identified in 50Á1% of patients. The probability of detecting a hereditary thrombophilia declined significantly with advancing age (from 49Á3% in patients aged 20 years and younger to 21Á9% in patients over the age of 70 years; P < 0Á001). This may be primarily attributed to the decreasing frequencies of the F5 R506Q (factor V Leiden) mutation and deficiencies of protein C or protein S with older age at the time of the initial VTE event. Moreover, thrombophilia was more prevalent in unprovoked compared with risk-associated VTE (57Á7% vs. 47Á7%; P = 0Á001). The decline in the prevalence of hereditary thrombophilia with older ages supports the use of a selected thrombophilia screening strategy dependent on age and the presence or absence of additional VTE risk factors.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

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Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry

et al. 2013

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“…This is consistent with findings from an American retrospective study which showed that thrombophilia testing is performed in an unstructured manner . Guidance in this area is limited (Table ), and epidemiological data from the German MAISTHRO registry and multination REITE registry did not clearly identify patient groups who will benefit from testing. It is also unclear if test results are altering management decisions.…”

Section: Discussionsupporting

confidence: 77%

Venous thromboembolism management practices and knowledge of guidelines: a survey of Australian haematologists and respiratory physicians

Wallace

Anderson

See

et al. 2017

Internal Medicine Journal

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“…Analysis of thrombophilia testing in large VTE datasets may enable evaluation of quality of care and clarification of issues surrounding thrombophilia testing (e.g., clinical utility, impact on outcomes). The only large, prospective, observational VTE cohort studies evaluating thrombophilia testing come from the RIETE initiative [7][8][9][10][11][12][13], which utilized detailed inpatient and outpatient medical record abstraction not easily replicated in other settings. Utilization of administrative datasets to assess the impact of thrombophilia offers the ability to study real-world patterns of care and patient outcomes in large numbers.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Algorithms to Identify Patients with Thrombophilia Following Venous Thromboembolism

Hsiao

Delate

Witt

et al. 2014

Blood

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BACKGROUND: Thrombophilia testing after venous thromboembolism (VTE) is controversial, and studies to-date have relied on medical record abstraction of lab results to assess patterns of testing and outcomes. Administrative databases are increasingly used for VTE outcomes research; however, the ability to identify thrombophilic patients in large datasets has not been evaluated. Our study examined how algorithms using ICD-9 codes and/or pharmacy data accurately reflect lab-based thrombophilia diagnoses. METHODS: This was a retrospective cohort analysis. We included patients ≥21 years old with their first VTE (based on the presence of an ICD-9 code for deep vein thrombosis [DVT] or pulmonary embolism [PE]) between 1/2004 and 12/2010 at Kaiser Permanente Colorado (KPCO). All VTE events were validated using manual chart review. We excluded patients with atrial fibrillation, prior VTE, warfarin prescription <3 years prior to VTE, <1 month of continuous health plan enrollment and drug benefits after VTE, recurrent VTE during follow-up, or provoked VTE (surgery <1 month or pregnancy <1 year prior to VTE, or active cancer). Patients were followed for 1 year after VTE. Thrombophilia lab test results were extracted from KPCO’s electronic lab database and confirmed with manual chart review as necessary. Tests included factor V Leiden/activated protein C resistance, prothrombin gene mutation, antithrombin activity, protein C activity, protein S activity, lupus anticoagulant (hexagonal phase and Russell’s viper venom time), cardiolipin immunoglobulin (Ig)G, and β-2 glycoprotein IgG. Patients were considered positive (+) for lab-confirmed thrombophilia if ≥1 test was positive, negative (-) if no tests were positive, and unknown if testing was not performed. “ICD-9 only” (+: ≥1 ICD-9 code for primary [289.81] or secondary hypercoagulable state [289.82], - otherwise) and “pharmacy only” criteria (+: extended anticoagulation [AC] >6 months after VTE, - otherwise) were applied individually and in combination (“combined ICD-9/pharmacy”) to identify possible thrombophilia cases. Using lab-confirmed thrombophilia as the gold standard, sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of the 3 thrombophilia identification strategies were calculated along with 95% confidence intervals (CIs). Baseline characteristics were analyzed overall and by thrombophilia test result status. RESULTS: Out of 1314 patients with VTE, 636 had an unprovoked clot and met our criteria for this study. The analytic cohort had a mean age of 62.7 years, 49.5% of the study patients were male, and 55.2% and 54.4% had a lower extremity DVT and PE, respectively. Thrombophilia testing was performed in 32.4% of the patients, and 7.6% of the analytic cohort had ≥1 positive test result. After applying the various algorithms, 6.5% had ≥1 ICD-9 thrombophilia code and 47.6% received extended AC following VTE. There were differences in the mean age (55.1 vs. 63.3 years), positive family history of VTE (18.8% vs. 6.1%), and presence of ≥1 ICD-9 thrombophilia code (35.4% vs. 4.1%) between the thrombophilia test + (n=48) and thrombophilia test -/unknown (n=588) groups, respectively (all p<0.05). There was no difference in the proportion of + or -/unknown thrombophilia patients who received extended AC following VTE. Sensitivity, PPV, specificity, and NPV results of each thrombophilia identification strategy are presented below. Table 1.Sensitivity % (95% CI)PPV % (95% CI)Specificity % (95% CI)NPV % (95% CI)ICD-9 only35.4 (22.2-50.5)41.5 (26.3-57.9)95.9 (94.0-97.4)94.8 (92.7-96.4)Pharmacy only45.8 (31.4-60.8)7.3 (4.6-10.8)52.2 (48.1-56.3)92.2 (88.8-94.8)Combined ICD-9/pharmacy18.8 (9.0-32.6)34.6 (17.2-55.7)97.1 (95.4-98.3)93.6 (91.4-95.4) CONCLUSIONS: ICD-9 codes for thrombophilia are highly specific for lab-confirmed cases. However, many patients with positive lab tests for thrombophilia do not get coded as such. Although utilizing extended AC as an identifier for patients with thrombophilia has a higher sensitivity than using ICD-9 codes alone or in combination, none of the 3 algorithms had a value >50%. Our results suggest that abstraction of lab results is still required to accurately capture all cases of thrombophilia. Further development of methods to identify thrombophilia status in large datasets is warranted. Disclosures Delate: Kaiser Permanente Colorado: Employment. Witt:Kaiser Permanente Colorado: Employment. Meyer:Kaiser Permanente Colorado: Employment. Go:Kaiser Permanente of Northern California: Employment. Fang:National Institutes of Health: Research Funding. Kim:Bayer: Consultancy.

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Thrombophilia and venous thromboembolism: RIETE experience

Cited by 11 publications

References 25 publications

Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry

Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry

Venous thromboembolism management practices and knowledge of guidelines: a survey of Australian haematologists and respiratory physicians

Assessment of Algorithms to Identify Patients with Thrombophilia Following Venous Thromboembolism

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